ArticleFamily practice2019
Gatekeeping function of primary care physicians under Japan's free-access system: a prospective open cohort study involving 14 isolated islands.
Article in Family practice, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Challenges in Help-Seeking Behaviors among Rural Older People Mitigated through Family Physician-Driven Outreach: A Systematic Review.International journal of environmental research and public health · 2022Pooled it
- Pharmacological management of knee and hip osteoarthritis stratified by oral nonsteroidal anti-inflammatory drugs safety status.Journal of bone and mineral metabolism · 2026Article
- Structural Mapping of Disease-Level Community-Based Care Patterns in Rural Clinics on Remote Islands in Japan: A Questionnaire Survey.Healthcare (Basel, Switzerland) · 2026Article
- Practice-Based Research Network Activities and Future Nationwide Plans in Japan.Journal of general and family medicine · 2026Article
- Review
- A Case of Traumatic Hyphema Diagnoses by Telemedicine Between a Remote Island and the Mainland of Tokyo.Cureus · 2024Article
- Factors associated with adherence to recommendations for medical visits following annual health checkups among Japanese employees: A prospective cohort study.Preventive medicine reports · 2024Article
- Improvement in Quality of Life through Self-Management of Mild Symptoms during the COVID-19 Pandemic: A Prospective Cohort Study.International journal of environmental research and public health · 2022Article
- Association between Self-Medication for Mild Symptoms and Quality of Life among Older Adults in Rural Japan: A Cross-Sectional Study.Medicina (Kaunas, Lithuania) · 2022Article
- Event Monitoring and Evaluation by Community Pharmacists in Japan: A Pilot Study on Fenofibrate and Pemafibrate.Current drug safety · 2022Article
- Predicting the Travel Distance of Patients to Access Healthcare Using Deep Neural Networks.IEEE journal of translational engineering in health and medicine · 2022Article
- The Association between the Self-Management of Mild Symptoms and Quality of Life of Elderly Populations in Rural Communities: A Cross-Sectional Study.International journal of environmental research and public health · 2021Article
- What resources do elderly people choose for managing their symptoms? Clarification of rural older people's choices of help-seeking behaviors in Japan.BMC health services research · 2021Article
- Patient Choice and Willingness Toward Gatekeepers as First-Contact Medical Institutions in Chinese Tiered Healthcare Delivery System: A Cross-Sectional Study.Frontiers in public health · 2021Article
- Do patients bypass primary care for common health problems under a free-access system? Experience of Taiwan.BMC health services research · 2020Article
- Performance and Sociodemographic Determinants of Excess Outpatient Demand of Rural Residents in China: A Cross-Sectional Study.International journal of environmental research and public health · 2020Article
- Associations of Patient Experience in Primary Care With Hospitalizations and Emergency Department Visits on Isolated Islands: A Prospective Cohort Study.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2019Article
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundGatekeeping is important for strong primary care and cost containment. Under Japan's free-access system, patients can access any medical institution without referral, which makes it difficult to evaluate the gatekeeping function of primary care physicians (PCPs).
objectivesTo examine the gatekeeping function of PCPs in Japan, we compared the frequencies of visits to primary care clinics, referrals to advanced care and hospitalizations between 14 remote islands and a nationwide survey.
methodsThis study was a prospective, open cohort study involving 14 isolated islands (12 238 inhabitants) in Okinawa, Japan. Participants were all patients who visited the clinics on these islands in 1 year. Main outcome measures were the incidence of on-island clinic visits and referrals to off-island advanced care.
resultsThere were 54 741 visits to the islands' clinics with 2045 referrals to off-island medical facilities, including 549 visits to emergency departments and 705 hospitalizations. The age- and sex-standardized incidences of healthcare use per 1000 inhabitants per month were: 360.0 (95% confidence interval: 359.9 to 360.1) visits to primary care clinics, 11.6 (11.0 to 12.2) referrals to off-island hospital-based outpatient clinics, 3.3 (2.8 to 5.2) visits to emergency departments and 4.2 (3.1 to 5.2) hospitalizations. Comparison with the nationwide survey revealed a lower incidence of visits to hospital-based outpatient clinics in this study, while more patients had visited PCPs.
conclusionsThe lower incidence of visits to secondary care facilities in this study might suggest that introduction of a gatekeeping system to Japan would reduce the incidence of referral to advanced care.
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